Khedr Eman M, Haridy Nourelhoda A, Korayem Mohammad A, Tawfik Ahmed Mamdouh, Hamed Ahmed A
Department of Neurology and Psychiatry, Assiut University, Assiut, Egypt.
Neurorehabil Neural Repair. 2025 Feb;39(2):126-137. doi: 10.1177/15459683241300547. Epub 2024 Dec 11.
Axial symptoms in Parkinson's disease (PD) often respond poorly to pharmacological treatment. We evaluated whether combining repetitive transcranial magnetic stimulation (rTMS) and repetitive spinal magnetic stimulation (rSMS) is more effective than rTMS alone in improving axial and other motor disabilities in PD.
A total of 42 PD patients with axial symptoms were randomly allocated to 2 experimental intervention groups: Group I received active rTMS + active rSMS (2000 pulses; 20 Hz; 80% resting motor threshold for each motor area "M1" + 1500 pulses rSMS 10 Hz, at 50% of maximal stimulator output). Group II received active rTMS + sham rSMS with the same number of pulses. Both groups received 10 sessions (5 consecutive days/week for 2 weeks). Assessments using Freezing of Gait Questionnaire, walking speed, Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) parts II and III, and Parkinson's Disease Questionaire-39 (PDQ-39) were performed at baseline (T0), end of sessions (T1), and 1 month later (T2).
At T0, Group II showed higher walking speed. At T1 and T2, Group I demonstrated significantly greater improvements in MDS-UPDRS parts II, III, and sub-items of part III. Group I showed stronger improvement in TUG-T and average fast velocity immediately post-intervention, but this effect diminished after 1 month. PDQ-39 scores for leisure activity and walking problems were significantly higher in group I.
These findings indicate that combining rTMS and rSMS for 10 sessions is more effective than rTMS alone in managing PD's motor and axial symptoms. The effect size of the outcome is large enough to be of significance in clinical practice.
The study was registered prospectively on 26/12/2021 at the clinicaltrial.gov website with the registration ID: NCT05271513, https://clinicaltrials.gov/study/NCT05271513.
帕金森病（PD）的轴性症状对药物治疗往往反应不佳。我们评估了重复经颅磁刺激（rTMS）与重复脊髓磁刺激（rSMS）联合使用在改善PD的轴性及其他运动功能障碍方面是否比单独使用rTMS更有效。
总共42例有轴性症状的PD患者被随机分配到2个实验干预组：第一组接受主动rTMS + 主动rSMS（2000次脉冲；20Hz；每个运动区“M1”的静息运动阈值的80% + 1500次脉冲rSMS，10Hz，刺激器最大输出的50%）。第二组接受主动rTMS + 假rSMS，脉冲数相同。两组均接受10次治疗（每周连续5天，共2周）。在基线（T0）、治疗结束时（T1）和1个月后（T2）使用步态冻结问卷、步行速度、运动障碍协会赞助的统一帕金森病评定量表（MDS-UPDRS）第二和第三部分以及帕金森病问卷-39（PDQ-39）进行评估。
在T0时，第二组的步行速度较高。在T1和T2时，第一组在MDS-UPDRS第二、第三部分以及第三部分的子项目上表现出明显更大的改善。第一组在干预后立即在定时起立行走测试（TUG-T）和平均快速速度方面有更强的改善，但这种效果在1个月后减弱。第一组的休闲活动和步行问题的PDQ-39评分显著更高。
这些发现表明，将rTMS和rSMS联合使用10次在管理PD的运动和轴性症状方面比单独使用rTMS更有效。结果的效应大小足够大，在临床实践中具有重要意义。
该研究于2021年12月26日在clinicaltrial.gov网站上进行前瞻性注册，注册号：NCT05271513，https://clinicaltrials.gov/study/NCT05271513 。
